Staged management of knee dislocation in polytrauma injured patients

Daraboš, Nikica; Gusić, Nadomir; Vlahović, Tomislav; Daraboš, Anela; Popović, Iva; Vlahović, Ivan

doi:10.1016/s0020-1383(13)70196-7

Cited by 24 publications

(18 citation statements)

References 41 publications

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“…first published this system in 1994, 61 but it was not until a presentation by Bill Clancy at the American Orthopaedic Society of Sports Medicine Annual Meeting in 1997 that the concept was routinely recognized and utilized by sports surgeons worldwide. 10 , 25 …”

Section: Anatomic Classification Of Knee Dislocationsmentioning

confidence: 99%

Knee Dislocations

Schenck

Richter

Wascher

2014

Orthopaedic Journal of Sports Medicine

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Background:Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking.Purpose:To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee.Study Design:Review and case reports.Methods:Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form–36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability.Results:The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject’s IKDC score to “C.”Conclusion:Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the future.

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Section: Anatomic Classification Of Knee Dislocationsmentioning

confidence: 99%

Knee Dislocations

Schenck

Richter

Wascher

2014

Orthopaedic Journal of Sports Medicine

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“…A thorough prioritized trauma evaluation is mandatory in all patients with high-velocity MLKIs. [4][5][6] The momentary deformity during a knee dislocation causes significant traction forces on important juxta-articular soft-tissue structures [ Figure 1].…”

Section: Associated Injuriesmentioning

confidence: 99%

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Held

North

Bormann

et al. 2020

JASSM

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Recent advances in the management of multiligament knee injuries have led to improvements in diagnosis and management and allowed enhanced understanding of the biomechanics of ligament reconstructions. Most studies arise from subspecialist knee centers in high-income countries and can inform global strategies, but each patient encounter and environment is unique and not all recommendations may be feasible in every setting. For ligamentous injuries, the gold standard is acute arthroscopic, single-stage ligament reconstruction, although this is not always possible in the limited resource setting (LRS). For these circumstances, non-operative management, although rarely promoted, may be preferred in selected patients. Furthermore, acute surgery relies on adequate post-operative physiotherapy, otherwise a delayed surgical approach should be considered. Reconstruction remains the gold standard, but acute repair is an option for medial collateral and posterior cruciate ligaments and for avulsion fractures. For a vascular examination, a careful clinical assessment and routine angiography should be done in LRS. Due to the heterogeneity of injury and patient profile, outcomes vary widely and need to be interpreted in the context of the surgical setup. The main complications of these injuries are stiffness, residual laxity, and surgical site infections. Future trends will need to include a global perspective and provide solutions for surgeons in various parts of the world.

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“…The repair of such ligament injuries can be delayed until the skeletal lesions have healed, although this is a subject of some debate among authors [ 43 , 47 ]. In any case, it seems advisable for the ligament repair to be performed in a single step procedure [ 48 ].…”

Section: Treatmentmentioning

confidence: 99%

Management of the Floating Knee in Polytrauma Patients

Bertrand¹,

Cano²

2015

TOORTHJ

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Ipsilateral fracture of the femur and tibia, or floating knee, is a rare injury that is found almost exclusively in polytrauma or high-energy trauma patients. It presents a combination of diaphyseal, metaphyseal and intra-articular fractures of the femur and tibia, with a high incidence of neurovascular, ligamentous and soft-tissue injuries. The functional outcome and, in some cases, the life, of such polytrauma patients depends largely on a correct therapeutic approach being taken. In general, the treatment decided upon will depend on the individual characteristics present, regarding aspects such as the patient’s general condition, the fracture line and the state of the soft tissues. The treatment provided may be the same as when single fractures are presented, but it is often necessary to consider whether certain techniques or surgical approaches may interfere with other lines of treatment. It is essential at all times to take into consideration the associated injuries and complications before deciding upon a treatment strategy. Ligamentous injuries play an important role in these injuries, much more so than when fractures occur singly. Therefore, these injuries require management by an experienced multidisciplinary team.

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Staged management of knee dislocation in polytrauma injured patients

Cited by 24 publications

References 41 publications

Knee Dislocations

Knee Dislocations

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Management of the Floating Knee in Polytrauma Patients

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